MEDICARE: MS. KAREN MARK LMSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker		NY

General Provider Information

NPI Number	:	1134338262
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KAREN MARK LMSW

Provider Business Mailing Address
First Line	:	107 W 25TH ST
Second Line	:	3B
City	:	NEW YORK
State	:	NY
Zip	:	10001-7202
Country	:	US
Telephone Number	:	212-255-0406
Fax Number	:

Provider Business Practice Location Address
First Line	:	3435 12TH ST # A
Second Line	:	RAVENSWOOD SENIOR CENTER
City	:	LONG ISLAND CITY
State	:	NY
Zip	:	11106-5057
Country	:	US
Telephone Number	:	718-609-1028
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/22/2007
Last Update Date	:	07/08/2007

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